Let's bring suicide out of the shadows

As more young men take their lives, a top psychiatrist reveals how a world increasingly dominated by 'feminine' skills is making it tougher for males. Raj Persaud talks to Jo Revill about his new role in engaging the public on the debate on mental health

The Golden Gate Bridge which spans San Francisco Bay is a structure that interests psychiatrists. As well as being an enormous tourist attraction, it is also the greatest suicide mecca in the world. Californians are gripped by a debate over how to lower the death toll. Should they put a fence around it? Would that deter potential suicide cases, or would they find another landmark to jump off? In any case, do they have any moral right to try to stop them?

Raj Persaud, one of Britain's best known psychiatrists and a man not afraid of putting forward his own point of view, is gripped by what happens on the bridge.

'If the drop down to the sea doesn't kill you then you're quickly swept out on the current, and you either die from drowning or the sharks. It's a one-way ticket, which is why it is so attractive to suicides.

'But what is interesting is that some people jump from the side which faces the city and others choose to jump from the side looking out to the bay. From a psychiatric point of view, jumping from the city side shows you are facing up to your life and its problems, and more than half of them choose that side.'

In his clinic, Persaud, consultant psychiatrist at the Maudsley Hospital in south London and the Institute of Psychiatry, has many conversations with patients who seem completely rational yet wish to kill themselves. He is now beginning a new role as visiting professor in the public understanding of psychiatry to Gresham College, London, delivering a series of free lectures during which he will examine how we see suicide.

Possibly more important, he would like to engage us all in a conversation over whether we could play a role in helping to prevent it.

Speaking at the Freud Museum in north London, dedicated to the father of psychoanalysis, Persaud was not sure how far to think of it as an act of insanity. 'The Freudian view is that the act of suicide is a repressed homicide, and how, by hating someone for leaving you, you turn the aggression in on yourself. In killing yourself, of course, you make the other people feel terrible.'

In his own clinic he sees patients who want to commit suicide but whose greatest desire is to think of an exit strategy which doesn't leave their family or friends upset. 'They usually plan to go missing,' he said. ' I then try to talk to them about whether going missing might not also leave family or friends upset.'

According to Persaud, presenter of BBC Radio 4's All in the Mind, most of us have had suicidal thoughts at some point, however fleeting. 'Why does Hamlet's soliloquy, "To be or not to be", leave us so moved? Because, at times, it seems bizarre to carry on living, simply not worth it any longer. The key factor seems to be how rooted or connected you are to others. Many people will have contemplated it, but what stops us is our connections with the people around us.'

He worries about what is happening to young British men, whose suicide rate has tripled since the 1980s, making it the leading cause of death for men aged between 19 and 35. Although suicide numbers fell slightly last year, the number of young men taking their lives - 1,300 a year in England - remains stubbornly high.

'There are several possible reasons,' said Persaud. 'Men tend to use different methods from women when taking their lives; whereas a woman might take an overdose of pills, which takes a long time to work, men shoot or hang themselves.

'But the world is also becoming a more feminine place. Verbal skills, the ability to communicate, are more valued now and aggression and competitiveness less so. Look at the programme Sex and the City. It features four women who are pretty and intelligent and it's about their dissatisfaction with the men they meet, as they're all wanting in some way. Female disappointment in the modern male is pretty rife, and a lot of men feel it and don't know what to do about it.'

The ability to admit vulnerability is not something many males achieve. 'Do you remember that scene in Sleepless in Seattle where the Tom Hanks character tries to talk about his depression, and his friend holds up his hand and gives him the card of his analyst? As a society, we are becoming increasingly unable, or unwilling, to listen to other people's problems.

'Leaving it to the doctors is not the answer; everyone needs to be able to unburden themselves at times to family or friends, and they also need to listen a bit more.'

To this end, Persaud and his team at the Institute of Psychiatry have started a new summer programme, aimed at helping teenagers in Camberwell, a fairly deprived part of London. They ask them in and try to get them talking about relationships.

'At first that's hard but the boys start to listen when you say to them, "Well, how do you get a date?" We want them to think about how they see the opposite sex, whether it's just about attraction or more about compatibility. What you find is that teenage girls have thought about it endlessly, whereas the boys haven't at all.'

Persaud is controversial for many of his views and is disliked by some colleagues for his willingness to do so much media work - he is best known as the shrink from ITV's This Morning and is widely quoted in all the newspapers. But he is unabashed by his high profile, arguing that the psychiatric profession is too secretive and too closed and that people can't be expected to understand mental illness unless the experts start talking about the issues with them.

He constantly brings the issue of suicide and depression back to the state of the family.

'One of the biggest determinants of your mental health is whether you choose the right marital partner. The evidence is that having an unhappy marriage will increase your chances of having depression not two- or three-fold, but 25-fold. Isn't that astonishing?

'And yet in the Western world, physical attraction and romance are seen as important, when it should be about compatibility. That's what we try to talk about with the children in Camberwell, but whether the message gets through is another matter.'